RESUMO
The incidence and distribution of ESBL producing microorganisms such as E. coli and K. pneumoniae have been demonstrated and varies in different health care facilities and as well as other countries This study was carried out to determine the frequency of occurrence and the antimicrobial susceptibility pattern of ESBL producing E. coli and K. pneumoniae species from clinical isolates at a tertiary hospital in Trinidad & Tobago. Standard microbiological procedures and automated MicroScan System was used to identify, screen for putative ESBL production and determine antimicrobial susceptibility of 1,118 clinical isolates of Enterobacteriaceae species at the microbiology laboratory of the Eric Williams Medical Science Complex, Trinidad & Tobago over a 36 months period. All ESBL producing isolates flagged by the automated system were further confirmed by E-test method. The E-test confirmed a 15.2 per cent ESBL rate among the K. pneumoniae isolates and 9.3 per cent among the E. coli isolates. There was also a 1.8 per cent rate of ESBL production in K. pneumoniae and 0.2 per cent in E. coli isolates from specimens received from community health facilities into the laboratory. Isolates recovered from the intensive care unit of the hospital had 2.1 per cent E. coli and 8.2 per cent K. pneumoniae ESBL producers. Although all ESBL positive isolates were completely susceptible to imipenem and meropenem; and all positive K. pneumoniae isolates were susceptible to amikacin, there was a low susceptibility of ESBL positive E. coli to the aminoglycosides. However, susceptibility of these ESBL producing isolates to the fluoroquinolones varied. There is a high rate of ESBL production among isolates of E. coli and K. pneumoniae at this hospital that is linked to the extensive inappropriate use of third generation cephalosporins in the country. Further molecular studies are needed to characterize the types of these ESBL prevailing in the country.
Assuntos
Humanos , Escherichia coli , Klebsiella pneumoniae , Enterobacteriaceae , Trinidad e TobagoRESUMO
The nosocomial infection rate in an Intensive care unit (ICU) of a private hospital was assessed during an 18-month survey. From 629 admissions to the ICU, 139 hospital-acquired infections were identified. The rate was 22.1 percent compared to the overall nosocomial infection rate of 15.3 percent for the entire hospital. In the ICU, the main infections occurred in the respiratory tract, 41 (29.5 percent), followed by surgical wounds, 35 (25.2 percent), urinary tract, 28 (20.1 percent) and the blood stream, 24 (17.3 percent). From 165 bacterial isolates, 80 percent of isolates were gram-negative rods, with P aeruginosa, 48 (36.6 percent), being the predominant gram-negative isolate followed by Klebsiella pneumoniae, 27 (20.6 percent), and Enterobacter sp, 22 (16.8 percent). The main gram-positive isolates were S aureus, 23 (41.8 percent), coagulase-negative Staphylococci, 17 (30.9 percent), and Enterococci, 11 (20.0 percent). Of the 23 S aureus strains, 15 (65.2 percent) were methicillin-resistant (MRSA), (8 MRSA were from surgical wounds, 5 from the respiratory tract and 2 from infected urine). Only 2 of the 17 (11.8 percent) coagulase-negative staphylococci were methicillin-resistant, and both were isolated from wounds. Resistance to ampicillin and augmentin (amoxicillin-clavulanic acid) was high, 81.9 percent and 55.4 percent, respectively. Gentamicin, azteronam, piperacillin-tazobactam showed resistance rates of less than 15 percent. Infection control measures aimed at reducing nosocomial infections at the hospital are often frustrated by apathy of hospital administrators who apparently are insensitive to the high nosocomial infection rate. Effort by the infection control team through seminars, lectures and newsletters have begun to show improvements in attitude and awareness of staff to infection control and preventative measures within the institution. (AU)
Assuntos
Humanos , Infecção Hospitalar/epidemiologia , Unidades de Terapia Intensiva/estatística & dados numéricos , Hospitais Privados/estatística & dados numéricos , Trinidad e Tobago/epidemiologia , Coleta de Dados , Infecções Respiratórias/epidemiologia , Infecção da Ferida Cirúrgica/epidemiologia , Infecções Urinárias/epidemiologia , Pseudomonas aeruginosa/isolamento & purificação , Bacilos e Cocos Aeróbios Gram-Negativos/isolamento & purificação , Klebsiella pneumoniae/isolamento & purificação , Enterobacter/isolamento & purificação , Bactérias Gram-Positivas/isolamento & purificação , Infecção Hospitalar/prevenção & controle , Staphylococcus aureus/isolamento & purificação , Gentamicinas/uso terapêutico , Aztreonam/uso terapêutico , Piperacilina/uso terapêuticoRESUMO
Cancrum oris (noma) has been most commonly described in malnourished debilitated children with poor oral hygiene following systemic childhood infections such as measles, pertussis or scarlet fever. We describe a patient who developed this condition during a period of profound neutropenia following cytotoxic chemotherapy for acute lymphoblastic leukaemia(AU)
Assuntos
Adulto , Relatos de Casos , Feminino , Humanos , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Leucemia-Linfoma Linfoblástico de Células T Precursoras/tratamento farmacológico , Neutropenia/induzido quimicamente , Noma/induzido quimicamente , Gangrena , Leucemia-Linfoma Linfoblástico de Células T Precursoras/patologia , Klebsiella pneumoniae , Infecções por Klebsiella/induzido quimicamente , Infecções por Klebsiella/patologia , Lábio/patologia , Mucosa Bucal/patologia , Neutropenia/patologia , Noma/patologia , Pseudomonas aeruginosa , Infecções por Pseudomonas/induzido quimicamente , Infecções por Pseudomonas/patologia , Indução de Remissão , Infecções Estafilocócicas/induzido quimicamente , Infecções Estafilocócicas/patologia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêuticoRESUMO
During the 1950s Staphylococcus aureus was the most frequently reported cause of nosocomial infection in hospitals. This paper describes an outbreak of colonization and infection due to Klebsiella pneumoniae in 14 infants in a neonatal special care unit
Assuntos
Humanos , Recém-Nascido , Masculino , Feminino , Infecção Hospitalar/epidemiologia , Surtos de Doenças , Unidades de Terapia Intensiva Neonatal , Infecções por Klebsiella/epidemiologia , Barbados , Sangue , Fezes , Klebsiella pneumoniaeRESUMO
The purpose of this study was to assess the role of upper respiratory and faecal carriage of Klebsiella as potential sources of infection in hospital patients. Weekly nose, throat and rectal swabs were taken from all patients and attendants in Wards 6 and 7, and ward dust and bedding sampled, to trace the sources of infection due to Klebsiella occurring in these wards. Nose and throat swabs were plated directly on to Blood and MacConkey agar and rectal swabs were sub-cultures from overnight Selenite broth suspensions. All positive cultures from any of the above sources were serotyped and biotyped and antibiotic resistance patterns done. The average incidence of commensal Klebsiella carriage in the two wards was 23 percent in throat swabs and 48 percent in rectal swabs, and the incidence rose with duration of hospital stay. Eighteen infections due to K. aerogenes occurred in the two wards under the period of study and 8 of these were due to autoinfection from organisms already present in the faecal flora (7 cases) or upper respiratory tract (1 case). Only 1 case of cross infection occurred in 18 weeks of study. It was assumed that autoinfection was the single most important factor in establishing Klebsiella infection. To investigate this further, 70 cases of Klebsiella infections from different wards were studied for carriage of the infecting serotype and biotype. This was present in the infected patient in 1.4 percent of nasal swabs, 14 percent of throat swabs and 38 percent of rectal swabs. Autoinfection by faecal flora therefore seems to be important in establishing infections due to Klebsiella organisms (AU)
Assuntos
Klebsiella pneumoniaeRESUMO
Klebsiella organisms are a common cause of urinary and pyogenic infections in the U.C.H.W.I. and not infrequently may cause death. These organisms show an in vitro sensitivity to streptomycin, tetracyclines and chloromycetin and litte antibiotic resistance appears to have developed over the last three years. The incidence of infection is particularly high in the gynaecological and obstetric wards and is common in the medical and paediatric wards. It is likely that the infection is being maintained and spread by cross infection and it is possible that the organism is present in the dust of the wards. (AU)
Assuntos
Humanos , Masculino , Feminino , Klebsiella/isolamento & purificação , Infecções por Klebsiella/diagnóstico , Infecções por Klebsiella/mortalidade , Jamaica , Klebsiella pneumoniae/isolamento & purificaçãoRESUMO
BACKGROUND: The accurate identification of a pathogen beyond the species level is critical in epidemiological studies and investigations of nosocomial outbreaks of infection. The clonal relatedness of 66 multidrug resistant (MDR) strains of extended spectrum beta-lactamase (ESBL) producing K. pneumoniae isolated from clinical specimens from hospitalized patients at a Jamaican hospital during a 5 year period were determined by pulsed field gel electrophoresis (PFGE). RESULTS: A total 10 different ESBL producing K. pneumoniae genotypes designated Clones I-X were found. The most frequently occurring strains belonged to Clones I (21/66, 32%), II (15/66, 26%), III (13/66, 20%) and IV (8/66, 12%) which accounted for 86% (57/66) of ESBL producing K. pneumoniae strains over the 5 year period. The remaining 9 (14%) cases of ESBL producing K. pneumoniae were due to strains of Clones V-X. The 4 predominant clones persisted for several years in the hospital. CONCLUSIONS: The clonal and temporal distribution of the MDR ESBL producing K. pneumoniae strains among clinical service areas did not suggest outbreaks of the organism during the period of study. Instead the molecular epidemiology of ESBL producing K. pneumoniae at this hospital was more representative of an endemic persistence of clones of the organism with limited dissemination from patient to patient. Further studies to investigate the factors which determine the emergence and persistence of MDR ESBL producing K. pneumoniae in Jamaican hospitals and their impact on clinical and economic outcomes at such institutions would be useful.